35 mm - University of Pennsylvania
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Transcript 35 mm - University of Pennsylvania
Macular Morphology and Visual Acuity
in the Comparison of Age-related
Macular Degeneration Treatments
Trial (CATT)
Jaffe GJ, Martin DF, Toth CA, Daniel E, Maguire, MG,
Ying G-S, Grunwald JE, Huang J for the CATT Research Team
Available through
http://www.med.upenn.edu/cpob/publications_main.shtml
Supported by Cooperative Agreements from the
National Eye Institute, National Institutes of Health,
DHHS
1
Presence and Type of Fluid on OCT Over Time
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
2
Impact Over Time of Drug & Dosing Regimen on
OCT–Determined Thickness Measurements
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
3
Retinal thickness category over
time by treatment group
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
4
Lesion Components Under the Foveal
Center by Drug and Dosing Regimen
Week
Foveal Intraretinal
Fluid Present
Yes
0
No
Yes
4
No
Yes
12
No
Yes
24
No
Yes
52
No
Retinal Thickness Category (µ)
Ranibizumab Monthly
Bevacizumab Monthly
Ranibizumab PRN
Bevacizumab
PRN
<120
120 to 212
>212
<120
120 to 212
>212
3(2.0%)
56(38.1%)
88(59.9%)
28(19.2%)
105(71.9%)
13(8.9%)
3(2.1%)
47(33.1%)
92(64.8%)
22(16.4%)
95(70.9%)
17(12.7%)
7(5.3%)
35(26.7%)
89(67.9%)
24(15.3%)
110(70.1%)
23(14.6%)
5(3.4%)
50(33.6%)
94(63.1%)
25(17.5%)
100(69.9%)
18(12.6%)
<120
120 to 212
>212
<120
120 to 212
>212
5(7.4%)
47(69.1%)
16(23.5%)
55(25.7%)
148(69.2%)
11(5.1%)
3(4.1%)
43(58.9%)
27(37.0%)
45(22.6%)
139(69.8%)
15(7.5%)
4(6.1%)
48(72.7%)
14(21.2%)
51(23.4%)
153(70.2%)
14(6.4%)
5(6.6%)
48(63.2%)
23(30.3%)
41(20.4%)
139(69.2%)
21(10.4%)
<120
120 to 212
>212
<120
120 to 212
>212
6(10.2%)
41(69.5%)
12(20.3%)
50(24.4%)
148(72.2%)
7(3.4%)
6(10.0%)
35(58.3%)
19(31.7%)
34(17.8%)
148(77.5%)
9(4.7%)
5(7.7%)
33(50.8%)
27(41.5%)
44(21.5%)
154(75.1%)
7(3.4%)
8(8.2%)
57(58.2%)
33(33.7%)
32(18.7%)
127(74.3%)
12(7.0%)
<120
120 to 212
>212
<120
120 to 212
>212
3(6.5%)
30(65.2%)
13(28.3%)
46(21.7%)
159(75.0%)
7(3.3%)
6(9.5%)
34(54.0%)
23(36.5%)
36(20.0%)
134(74.4%)
10(5.6%)
3(5.3%)
34(59.6%)
20(35.1%)
53(25.6%)
142(68.6%)
12(5.8%)
8(10.1%)
43(54.4%)
28(35.4%)
36(20.8%)
128(74.0%)
9(5.2%)
<120
120 to 212
>212
<120
120 to 212
>212
2(7.7%)
17(65.4%)
7(26.9%)
69(28.4%)
163(67.1%)
11(4.5%)
6(11.8%)
23(45.1%)
22(43.1%)
42(20.8%)
146(72.3%)
14(6.9%)
4(8.7%)
27(58.7%)
15(32.6%)
49(22.0%)
161(72.2%)
13(5.8%)
4(7.0%)
33(57.9%)
20(35.1%)
49(24.0%)
139(68.1%)
16(7.8%)
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
5
Foveal Lesion Composition
Baseline
Week 52
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
6
Involvement of the foveal center by CNV
or sequelae of CNV at week 52
(A)Ranibizumab Monthly
Non-geographic
Atrophy
18.5%
(B) Bevacizumab Monthly
Geographic
Atrophy
2.6%
Geographic
Atrophy 0.8%
Fluid Only
10.9%
Blocked
Fluorescence
5.3%
CNV
21.5%
Can't Grade
3.0%
Other
2.3%
Blocked
Fluorescence
4.9%
CNV 21.2%
SPED 0.4%
No Pathology
24.9%
Scar 20.4%
RPE Tears 0.8%
Scar
RPE Tears 16.2%
1.5%
Other 4.9%
(C) Ranibizumab PRN
Non-geographic
Atrophy 14.5%
Fluid Only 8.2%
Can't Grade
1.6%
SPED
0.4%
No Pathology
17.7%
Non-geographic
Atrophy 11.8%
(D) Bevacizumab PRN
Geographic
Atrophy 1.1%
Fluid Only 4.5%
Blocked
Fluorescence
3.4%
CNV 26.5%
Non-geographic
Atrophy 13.3%
Geographic
Atrophy 3.1%
Fluid Only 9.4%
CNV 29.8%
Blocked
Fluorescence
1.6%
Can't Grade
2.4%
Can't Grade 3.4%
No Pathology
20.1%
SPED 1.1%
No Pathology
16.1%
SPED 0.4%
Other 3.9%
Other 4.8%
RPE Tear 0.7%
Scar 18.8%
Scar 19.0%
Hemorrhage
0.7%
RPE Tears 0.8%
Hemorrhage
0.4%
7
Mean visual acuity by status of fluid
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
8
Retinal thickness and Visual Acuity
at Baseline and Follow-up
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
9
Nonlinear relationship of visual acuity with
foveal total thickness during follow-up
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
10
Mean VA by Neovascular Lesion Area and
Pathology in Foveal Center at Week 52 (N=1053)
Fundus Feature at Week 52
Neovascular lesion area (mm2)
≥0 to ≤1.92
>1.92 to ≤4.96
>4.96 to ≤9.62
>9.62
Missing
Pathology in foveal center
None
Fluid only
Choroidal neovascularization or
serous pigment epithelium
detachment
Non-geographic atrophy
Geographic atrophy,
hemorrhage, RPE§ tear,
blocked fluorescence
N
Unadjusted Mean
Visual Acuity Score
(Standard Error)
P values*
<0.0001
244
246
74.3 (1.11)
70.4 (1.10)
245
242
76
67.1 (1.10)
61.9 (1.11)
63.1 (1.98)
<0.0001
202
85
259
73.9 (1.20)
75.3 (1.85)
69.7 (1.06)
151
66.5 (1.39)
72
64.8 (2.01)
Scar
188
59.5 (1.25)
Other§ or missing
96
66.8 (1.75)
*1-way analysis of variance
RPE = retinal pigment epithelium
§Other includes pigment, drusenoid pigment epithelial detachment and non-leaking choroidal neovascularization
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
11
Adjusted Mean Visual Acuity for OCT and
Fundus Features at Week 52 (n=1004)∗
*Subjects (n=49) with missing data for fluid or retinal thickness were excluded.
CNV= choroidal neovascularization
RPE = retinal pigment epithelium
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03
12
Conclusions
Anti–vascular endothelial growth factor (VEGF) therapy reduced
lesion activity and improved VA in all treatment groups.
At all time points, eyes with residual IRF had worse VA than those
without.
Eyes with abnormally thin or thick retinas, residual large lesions,
and scar also had worse VA.
Monthly ranibizumab dosing yielded more eyes with no fluid and
an abnormally thin retina, although the long-term significance is
unknown.
These results have important treatment implications in eyes
undergoing anti-VEGF therapy for neovascular
Jaffe et al. Macular Morphology and Visual Acuity in the Comparison of Age-related Macular Degeneration Treatments Trials Ophthalmology Epub 2013 May 03